The Clinical journal of pain
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To describe the prevalence and characteristics of flare-ups of chronic nonspecific back pain (CNSBP) among primary care patients, and to examine associations with measures of pain severity and psychosocial factors. ⋯ Flare-ups of CNSBP are common among primary care patients, and are independently associated with higher levels of pain intensity, disability, and passive coping. The presence of flare-ups and the perception of activity as a trigger may predispose patients with flare-ups to experience disability not explained by pain intensity alone. Further longitudinal studies are required to better characterize CNSBP flare-ups and determine their clinical implications.
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To evaluate if sensory, motor, and psychological factors are different in severe lateral epicondylalgia compared with less severe cases and control. ⋯ Lateral epicondylalgia patients presenting with severe pain and disability could be distinguished by hypersensitivity to thermal stimuli, notably bilateral cold hyperalgesia. Findings may implicate a combination of central, peripheral, and sympathetic nervous system processes and may help explain the poorer outcomes found in this subpopulation.
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Altered activation of the deep cervical flexors (longus colli and longus capitis) has been found in individuals with neck pain disorders but the response to training has been variable. Therefore, this study investigated the relationship between change in deep cervical flexor muscle activity and symptoms in response to specific training. ⋯ Specific training of the deep cervical flexor muscles in women with chronic neck pain reduces pain and improves the activation of these muscles, especially in those with the least activation of their deep cervical flexors before training. This finding suggests that the selection of exercise based on a precise assessment of the patients' neuromuscular control and targeted exercise interventions based on this assessment are likely to be the most beneficial to patients with neck pain.
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Impaired left/right judgment of the affected body part is regarded as a disruption of the body's representation in cortical and subcortical somatosensory and motor areas and has previously been demonstrated in patients with severe neuropathic pain states. It remains unknown whether persistent but less severe pain states are sufficient to induce a similar impairment. ⋯ This study demonstrates that individuals with CTS present with a selective impairment in left/right judgment that is restricted to the affected quadrant. This indicates that left/right judgment is impaired in much less severe pain states than previously demonstrated. The findings are in line with previous reports, which suggested the presence of central mechanisms in patients with CTS.